Pathologia

Transformation of adenocarcinoma into small cell lung cancer as one of the mechanisms of acquired resistance to anti-EGFR tyrosine kinase inhibitors

O. O. Kovalov — 2024-04-22

Transformation of adenocarcinoma into small cell lung cancer (SCLC) is a rare and unique biological property of a cancer cell that is responsible for the mechanism of acquired resistance to EGFR tyrosine kinase inhibitors.

There are very few clinical observations of phenotypic cellular transformation during metastatic progression of lung cancer in the literature.

The aim of the work is to demonstrate clinical observation of phenotypic transformation of metastatic EGFR-mutated adenocarcinoma into small cell lung cancer with neuroendocrine differentiation during therapy with tyrosine kinase inhibitors.

Case report. Due to the rarity of this biological phenomenon, we describe our own observation of the transformation of EGFR-mutated metastatic adenocarcinoma into DCLC with neuroendocrine differentiation, which occurred in a 42-year-old woman during treatment with gefitinib.

Conclusions. Transformation and changes in cell phenotype during tyrosine kinase inhibitor therapy were the cause of resistance and failure of further treatment with osimertinib in the second line. It was concluded that it is necessary to consider this mechanism of resistance in clinical practice and to perform repeat biopsies during metastatic progression in patients with EGFR-mutated lung adenocarcinoma.

The impact of renal tubulointerstitial dysfunction on the early and long-term prognosis in chronic heart failure patients with preserved left ventricular ejection fraction

V. V. Syvolap — 2024-04-22

Aim. To study the dependence of the early-term (1 year) and long-term (5 years) prognosis in patients with chronic heart failure (CHF) of ischemic origin with preserved left ventricular ejection fraction (LVEF) depending on renal tubulointerstitial functional disorders.

Materials and methods. The study involved 88 patients (men – 46.6 % (n = 41); women – 53.4 % (n = 47)) with CHF of ischemic origin, stage II A–B, stage II–IV according to NYHA, 67 % (n = 59) with sinus rhythm, and 33 % (n = 29) with atrial fibrillation. Patients with sinus rhythm and atrial fibrillation were matched in age (p = 0.483), height (p = 0.345), weight (p = 0.317), body surface area (p = 0.153). NGAL levels were analyzed using an ELISA kit (E-EL-H0096, Elabscience, USA). NAG levels were analyzed using an ELISA kit (SEA 069 Hu, Cloud-Clone Corp., USA). KIM-1 levels were analyzed using an ELISA kit (SEA 785 Hu, Cloud-Clone Corp., USA). Kaplan–Meier curves and Cox proportional hazards regression analysis were performed.

Results. No significant difference was found in the frequency of the cumulative endpoint during the first-year follow-up from the initial level of two markers of tubulointerstitial injury – KIM-1 (Log-Rank Test: p = 0.57529) and NAG (Log-Rank Test: p = 0.86001). According to the results of analysis of the Cox proportional hazards, only a tendency to increase in the risk factors of adverse events were observed in case of elevated KIM-1 (HR = 1.66; p = 0.5795) and NAG levels (HR = 1.1712; p = 0.8626) in this CHF patients’ cohort. Kaplan–Meier analysis revealed a probable (Log-Rank Test; p = 0.00141) increase in the frequency of the cumulative endpoint during the first year of follow-up in CHF patients with preserved LVEF due to increased serum NGAL level more than 168 ng/ml. According to the univariate model, an elevated serum NGAL level is associated with an increase in the relative risk by 4.2 times (95 % CI 1.78–16.89; p = 0.014). A reduced sodium level less than 142.5 mmol/l was associated with an increase in number of adverse cardiovascular events during the first-year follow- ups by 22 % (HR = 1.22, p = 0.029). After 5 years of follow-up, a decrease in sodium level less than 142.3 mmol/l is also characterized by a probable difference of the cumulative Kaplan–Meier’s curves (Cox–Mantel F-Test, p = 0.00287). According to the univariate model of Cox proportional hazards, the relative risk of adverse cardiovascular events in patients with CHF during the 5-year follow-up has a tendency to increase by 1.04 times (95 % CI 0.85–1.27; p = 0.72). Serum NGAL, a marker of renal tubulo-interstitial injury, doesn’t lose its properties as a powerful marker of an unfavorable long-term prognosis in patients with CHF with preserved LVEF (HR = 5.96; 95 % CI 1.17–30.50; p = 0.032).

Conclusions. The most powerful factors of the early (1-year) prognosis of adverse cardiovascular events in CHF patients with preserved left ventricular ejection fraction are the marker of tubulointerstitial injury, serum NGAL over 168 ng/ml, as well as the marker of tubulointerstitial dysfunction – the serum sodium level less than 142.5 mmol/l. The electrolyte imbalance, decreased sodium level less than 142.3 mmol/l, remains a powerful marker of an unfavorable long-term 5-year prognosis in CHF patients with preserved left ventricular ejection fraction, meanwhile serum NGAL, a marker of renal tubulointerstitial injury, besides doesn’t lose its prognostic value (HR = 5.96; 95 % CI 1.17–30.50; p = 0.032), but also is independent from the parameters of the age (p = 0.409) and gender (p = 0.397) in such patients.

Evaluation of anti-inflammatory properties on the surface of dental implants depending on the type of processing (Part 1)

S. D. Varzhapetian — 2024-04-22

The aim. To study of the anti-inflammatory properties of the surface of commercial dental implants with different processing methods using the example of the course of the first stage of implantation.

Materials and methods. Dental implants made of titanium with 3D Active and Xpeed surface treatment were used. The surface microstructure and biocompatibility of the samples, surface corrosion, elemental analysis of the surface was studied. The assessment of the severity of peri-implantitis and mucositis based on the depth of the peri-implant pocket and bleeding during probing, determination of the coefficient of stability of implants (KSI) is given. Median test (χ²), Kruskel–Wallis test (H), univariate variance analysis (F) were used for multiple comparison of samples. The difference in parameters was considered statistically significant at the p ≤ 0.05 level.

Results. The surfaces of 3D Active implants are monolithic with rounded pores in the form of wells of different diameters and depths; the upper layer of the Xpeed sample consists of closely adjacent to each other fragments of a rectangular or polygonal shape, in the form of tiles, leaving rectangular faces on the outside. On the surface of the 3D Active samples, in addition to oxygen and carbon, there was phosphorus – 5.04 wt%, as well as S, Ca, Na, Zr, Zn which weight percentage did not exceed 1 wt%. A significant difference in the elemental composition of Xpeed implants was the presence of chlorine 0.07 wt% and 0.93 wt%, silicon – 0.10 wt% and 0.14 wt%, aluminum 0.06 wt% and 0.23 wt%, respectively, with the latter has a significant advantage in these elements. Xpeed had an insignificant weight percentage of iron in its composition – 0.12 wt%.

The assessment of cell adhesion to the surface of the samples on the first day of incubation demonstrated that the samples with the Xpeed and 3D Active surfaces did not have a statistically significant difference between them. Also, on the 7^th day of incubation, the level of reduction of resazurin in Xpeed was lower, no significant difference was observed (p > 0.05).

The clinical signs of bone tissue resorption were identified in 36.4 % of 3D Active implants and 60.0 % of Xpeed implants (p = 0.3); inflammation of the mucous membrane – in the areas of installation of 54.5 % of 3D Active implants. No signs of mucositis were detected around the Xpeed implants (p = 0.23). 9.1 % of 3D Active implants were “lost”; no cases of loss of Xpeed implants have been identified. The KSI of 3D Active – 64.0 ± 5.9 units, Xpeed – 65.1 ± 3.7 units.

Conclusions. According to KSI indicators, titanium implants with Xpeed coating (65.1 ± 3.7 units) and 3D Active (64.0 ± 5.9 units) showed the same capabilities. Bone tissue resorption without signs of inflammation is more common around Xpeed-coated implants than 3D Active-coated implants. Clinical signs of inflammation are more frequent and more severe around implants with a 3D Active coating, which affected both the severity of the course of the first stage of implantation and its results. Xpeed-coated implants are more reliable than 3D Active: loss among 3D Active implants was 9.1 %, Xpeed – 0.0 %.

Characteristic of a group of genes with low level of expression in the pancreas of rats under conditions of multi-day intermittent hypoxia influence

T. V. Ivanenko — 2024-04-22

In modern medical science great attention is paid to the clarification of the molecular mechanisms, which are the basis of adaptation to environmental factors of unusual origin and/or extraordinary strength.

The aim of the study is to determine the features of a group of genes with low expression level, associated with hypoxia in the pancreas of Wistar rats under conditions of intermittent hypoxia.

Materials and methods. The study was conducted on 10 white, sexually mature Wistar rats, which were divided into 2 groups (5 animals in each). Animals of group 1 were part of the control (intact) group. The animals of the 2^nd group were subjected to hypoxic training according to the following scheme: for 15 days, 6 hours daily, namely on days 1–5 they simulated an ascent to a height of one to five kilometers above sea level under the conditions of a barometer, and the last 10 days 6 km above the sea level.

To analyze gene expression, we used the polymerase chain reaction method with real-time reverse transcription (PCR) CFX-96 Touch™ (Bio-Rad, USA) and the RT2 Profiler™ PCR Array Rat Hypoxia Signaling Pathway kit (QIAGEN, Germany), where 84 genes were the subject of research in experimental animals.

Results. According to the results of the PCR study of genes in the pancreas samples of intact animals and animals exposed to hypoxic training, it was established that out of 84 genes associated with hypoxia, a group of 5 genes with a low expression level (∆∆Ct < 30) was found. This pattern includes Bhlhe40 genes, Ctsa, Hif1a, Lox, and Slc16a3, the expression of which is statistically reduced. Thus, compared to the level of their expression in intact animals, the expression of Bhlhe40 decreased by 2.59 times, Ctsa by 6.02 times, Hif1a by 3.85 times, Lox by 3.01 times, and Slc16a3 by 2.40 times.

Conclusions. Intermittent hypoxia reduces the expression of the Bhlhe40 gene by 2.59 times, which can be considered as an element of adaptation of cells to a low level of oxygen and modulation of genetic programs. The decrease in Ctsa gene expression by 6.02, Hif1a by 3.85, and Lox by 3.01 times during intermittent hypoxia demonstrates, that these effects can be used as sanogenic factors in insulin resistance and type 2 diabetes. The 2.40-fold decreased expression level of Slc16a3 is probably an element of metabolic adaptation and adaptation of the metabolic pathway of cells to hypoxia conditions.

Influence of trace elements changes in the cerebellum on the rat’s behavior in elevated plus maze in the early period of mild blast-induced traumatic brain injury

Yu. V. Kozlova — 2024-04-22

The aim of the current study was to determine whether there are changes in brain trace elements of rats with blast-induced trauma and if these changes affect behavior in the elevated plus maze.

Materials and methods. The study was carried out on 126 sexually mature male Wistar and were divided into 3 groups: Experimental – exposed to a shock wave 26.4 ± 3.6 kPa (n = 42); Sham (n = 42), the animals of which were subjected to inhalation anesthesia with halothane and fixation in a horizontal position; and Intact (n = 42). Behavior was study in elevated plus maze. The duration of presence in the open and closed arms, the number of stands, the duration of grooming was recorded in all groups of rats for 3 minutes. After, the animals were euthanized with halothane, followed by removal of the brain. The cerebellum was completely separated for spectral analysis using energy dispersive X-ray fluorescence analysis (EDRFA) on the analyzer EXPERT 3 XL.

Results. Results showed significant changes of cognitive activity in experimental group which are indicate functional disorders of the cerebellum in the form of maladaptation in space with subsequent inhibition of motor centers. Cu/Fe ratio was decreased in the 14^th and 21^st days and increased in the 28^th. Cu/Zn ratio was decreased on the 14th day. Zn/Fe ratio was higher on the 14^th and 28^th days. The existence of correlations between changes in trace elements and behavioral disorders in experimental rats was established.

Conclusions. In the early period of blast-induced traumatic brain injury, cerebellar dysfunction in the form of spatial maladaptation with subsequent depression of motor centers was observed in the experimental rats Correlation analysis showed the presence of different strengths and directions of relationships between the ratios of Cu/Fe, Cu/Zn and Zn/Fe in the cerebellum and behavioral indicators in the elevated plus maze (duration of stay in open and closed arms, grooming and vertical motor activity) of experimental rats.

Serotonin blood level study, anxiety-depressive states indicators and patients life quality after laparoscopic treatment of gastroesophageal reflux disease

Ye. I. Haidarzhi — 2024-04-22

Nowadays effective treatment of gastroesophageal reflux disease (GERD) remains a difficult and still unsolved problem. The use of various antisecretory drugs in combination with surgical treatment does not allow to achieve a long lasting improvement of the quality of life and reliable prevention of complications. In this regard, special attention is paid to study humoral factors influencing the pathogenesis of GERD, data on which will improve the results of therapeutic and surgical treatment. It is promising to study the dynamics of serotonin after laparoscopic treatment of various types of GERD, especially in combination with dyspepsia, anxiety or depressive disorders, as well as the possibility of using drugs that affect the metabolism of this hormone to correct the above mentioned disorders and achieve long lasting recovery after laparoscopic fundoplication.

The aim of the work was to study the dynamics of serotonin in the blood during laparoscopic total fundoplication and analyze the correlation of this hormone with the psychological well-being of patients before and after surgical treatment of GERD.

Materials and methods. Laparoscopic fundoplication by Short Floppy Nissen modification was performed in 35 patients with GERD. There were 26 (74.3 %) women, 9 (25.7 %) men. Age – 55.3 ± 11.3. The comparison group consisted of 20 healthy volunteers (women – 14 (70.0 %); men – 6 (30.0 %), average age – 56.7 ± 10.6), who did not undergo surgery. The groups were comparable by gender and age. The studies were carried out in venous blood plasma, samples of which were maintained using standard methods and stored in a low-temperature freezer at a temperature of -80 °C. Tests for serotonin (Serotonin ELISA, RE59121, IBL) were studied on the immunoenzyme complex ImmunoChem-2100 (USA) of the Department of Clinical Laboratory Diagnostics in the Zaporizhzhia State Medical and Pharmaceutical University. The concentration of the last indicators was expressed in ng/ml. The presence of concomitant anxiety, depression and level of psychological well-being was assessed using the GAD-7, PHQ-9 and SF-36 questionnaires. Statistical assessment of the research results was carried out using the Statistica for Windows 13 software package (StatSoft Inc., No. JPZ804I382130ARCN10-J). Differences were considered statistically significant at p < 0.05.

Results. The serotonin level in the blood of practically healthy people was 5.8 ± 1.5 ng/ml. In the main group serotonin values before surgical treatment were 3.1 ± 1.3 ng/ml. After surgical treatment the serotonin level increased to 5.4 ± 1.8 ng/ml and was not statistically different from the level of practically healthy patients. The dynamics of serotonin levels correspond to the dynamics of the patients number with signs of anxiety and depression before and after surgery in the main group, as well as the improvement in the psychological state of patients after surgery compared to preoperative data on the scales of the “psychological component” of SF-36 health questionnaire: Vitality (VT), Social Functioning (SF), Role-Emotional (RE), Mental Health (MH).

Conclusions. Laparoscopic crurorrhaphy and fundoplication in the Short Floppy Nissen modification through the mechanism of serotonin helps to improve the psychological state of patients with GERD in the postoperative period, eliminate anxiety and depression, improve quality of life and achieve a lasting antireflux effect. The obtained dynamics of serotonin levels confirms its participation in the formation of behavioral reactions in GERD, helping to improve the results of surgical treatment.

Influence of dapagliflozin on cardiovascular remodeling in hypertensive patients with accompanying type 2 diabetes

A. O. Bohun — 2024-04-22

Aim. To compare the results of 12-week treatment of patients with stage II hypertension (HTN) with accompanying diabetes mellitus (DM) type 2 between the combination of metformin + dapagliflozin and metformin monotherapy by studying changes in the elastic properties of the common carotid arteries (CCA), echocardiographic indicators, 24-hour ambulatory blood pressure monitoring (ABPM) and laboratory parameters of lipid and carbohydrate metabolism.

Materials and methods. 24 patients with stage II HTN with type 2 DM were involved in the study, the average age was 60.4 years, 50 % – men. Patients in the first group were randomized to receive metformin, and the second group – to receive a combination of metformin and dapagliflozin. At inclusion and after 3 months of treatment, basic anthropometric data, laboratory indicators of lipid and carbohydrate metabolism, ABPM, echocardiography, and indicators of CCA local stiffness were studied. Statistical analysis was performed, the probability of differences is at the level of p < 0.05.

Results. In both observation groups, there was a comparable decrease in SCORE 2-Diabetes range, glucose and glycated hemoglobin, total cholesterol, LDL cholesterol, average daily systolic blood pressure (SBP), daily SBP load, day and night pulse BP, as well as an increase in speed systolic movement of the lateral fibrous ring of the mitral valve (S lat).

Only in the metformin + dapagliflozin group a decrease in the adipose tissue level, the average daily diastolic blood pressure (DBP), the burden of DBP, the size of the left atrium and right ventricle, an increase in the movement speeds of the medial (e’med), lateral (e’lat) ring of the mitral and of the tricuspid (e’tk) valve in the period of early diastolic filling of the ventricles, velocities of systolic movement of the medial fibrous ring of the mitral (S med) and tricuspid (S tk) valves, a decrease in the ratio E/e’, and an improvement in the elastic properties of general carotid arteries were observed.

Conclusions. In persons with HTN stage II with DM type 2 the addition of dapagliflozin to the treatment regimen was associated with better control of blood pressure, improvement of diastolic function and longitudinal contractility of the left ventricle, elastic properties of CCA.

Proliferation activity and hormonal status of atypical hyperplasia and endometrioid adenocarcinoma of the endometrium

P. V. Savchenko — 2024-04-22

Atypical hyperplasia of the endometrium is a precancerous condition for endometrioid adenocarcinoma of the endometrium, which is the largest group among malignant neoplasms of the uterine body, according to the Cancer Registry, the mortality rate from which took the 3^rd place in 2021. The absence of specific clinical manifestations complicates diagnostics at the early stages of the process, which necessitates the study of histological and immunohistochemical criteria to verify the diagnosis.

The aim of the study. To improve the differential diagnostic morphological and immunohistochemical criteria for the diagnosis of atypical hyperplasia and endometrioid adenocarcinoma of the endometrium, using the latest international classification data.

Materials and methods. Retrospective analysis of 76 cases of postoperative material of women for the period from 2020 to 2022 with a diagnosis of “endometrioid adenocarcinoma of the endometrium” – 61 cases and “endometrial hyperplasia with atypia” – 15 included an assessment of histological, immunohistochemical features, followed by statistical processing of the obtained results.

Results. The incidence of endometrioid adenocarcinoma of the endometrium and atypical endometrial hyperplasia occurs in the premenopausal and menopausal periods. The expression level of the Ki-67 marker is directly proportional to the degree of tumor malignancy (p < 0.05). Estrogen receptors decrease as the degree of tumor malignancy increases. Progesterone receptors are equally present in endometrioid adenocarcinomas and atypical endometrial hyperplasia (p < 0.05).

Conclusions. The necessity of using the Ki-67 marker and determining the hormonal status in endometrioid adenocarcinomas of the endometrium and atypical hyperplasia of the endometrium is argued.

The role of clinical and anamnestic data in the primary diagnosis of genital endometrios

T. V. Skapchuk — 2024-04-22

To date, many randomized studies have proven the importance of evaluating clinical and anamnestic data in the initial diagnosis of genital endometriosis. Clinical assessment of “classic” complaints of patients, which are characteristic of genital endometriosis, allows to predict the presence of endometriosis with a high probability, which is an important component of choosing the optimal treatment tactics. Despite a fairly significant number of developed questionnaires for the assessment of endometriosis symptoms, none of them has been widely used among domestic clinicians. Implementation of a diary of symptoms of endometriosis in practice will allow to more carefully assess the general pain of endometriosis, the impact on the patient’s quality of life, and also to evaluate the quality of the chosen method of treatment.

The aim of the study: on the basis of a retrospective analysis of patients’ disease histories, assessment of the presence of clinical and anamnestic data characteristic of genital endometriosis in accordance with the obtained results of pathohistologically confirmed endometriosis.

Materials and methods. We performed a retrospective analysis of 160 patient histories. The criteria for selecting patients with genital endometriosis were the presence of the following symptoms: premenstrual pain syndrome, dysmenorrhea, dyspareunia, the nature of menstrual discharge (brown discharge before and after menstruation), chronic pelvic pain, as well as confirmation, with the help of histopathological examination, of genital endometriosis.

Results. By comparing the obtained data on pain symptoms with the clinical diagnosis made on the basis of histopathological examination, it can be concluded that the symptoms were most likely caused by endometriosis.

Conclusions. Clinical and anamnestic data most characteristic of genital endometriosis were found in 138 (86.25 %) patients, data on the frequency of combination of painful symptoms were as follows: combination of two symptoms in 27.50 % (n = 44), three symptoms in 26.88 % (n = 43), four symptoms in 14.38 % (n = 23) and five studied symptoms in 6.25 % (n = 10), which in turn influenced the choice of the expected volume of surgical intervention and contributed to the establishment of a clinical diagnosis. The description of pain symptoms is quite limited, since the assessment of the characteristic symptoms of genital endometriosis did not include: conducting additional examinations in order to exclude additional causes of functional pain in the pelvis, the description of pain symptoms was incomplete, which, in turn, minimized the assessment of the adverse impact on daily activities, work or the quality of life in general, characteristic of pain symptoms, there is no clear difference between chronic pelvic pain and dysmenorrhea, the absence of data regarding the work of the gastrointestinal tract and urinary system, regarding the symptoms of genital endometriosis, which may indicate damage to the above-mentioned departments.

Results of patient survival after surgical interventions for complicated forms of colon cancer performed in general surgical hospitals

M. A. Kubrak — 2024-04-22

The aim of the study: to evaluate the 1- and 3-year survival of patients operated for complicated forms of colon cancer (СC) in general surgical hospital.

Materials and methods. The study group included 71 (100 %) patients with complicated forms of СС. Acute intestinal obstruction was detected in 49 (69.1 %) patients, tumor perforation – in 13 (18.3 %), acute colonic bleeding – in 3 (4.2 %) patients, a combination of acute intestinal obstruction with tumor perforation – in 4 (5.6 %) and intestinal obstruction with bleeding – in 2 (2.8 %) operated patients. Radical operations were performed in 48 (67.6 %) patients, palliative operations – in 18 (25.4 %), symptomatic operations – in 5 (7.0 %) patients. II stage of the disease was diagnosed in 15 (21.1 %), III stage – in 32 (45.1 %), IV stage – in 24 (33.8 %) operated patients. 19 (30.2 %) patients underwent specific chemotherapy after surgery.

Results. Among patients with the II stage of the oncological process 1-year survival was 76.9 ± 11.7 %, 3-year – 53.8 ± 13.8 %; with stage III, 1-year survival was 65.6 ± 8.4 %, 3-year – 50.0 ± 8.8 %; in persons with IV stage of СC – 29.2 ± 9.3 % and 8.3 ± 2.6 % respectively (χ² = 21.8, p = 0.0001). Among male patients, 1-year survival was 51.4 ± 8.5 %, 3-year – 31.4 ± 7.9 %; women – 61.1 ± 8.1 % and 44.4 ± 8.3 %, respectively (χ² = 2.3, p = 0.1302). Better indicators were found in the case of cancer of the left sections of the large intestine than the right sections – the 1-year survival rate was 60.4 ± 7.1 % and 43.5 ± 10.3 % respectively; 3-year – 39.6 ± 7.1 % and 30.4 ± 9.6 % (χ² = 0.74, p = 0.3906).

Conclusions. The conducted analysis indicates a clear dependence of the survival results on the stage of the disease, gender and localization of the tumor process.

Simultaneous operations in patients with combined pathology of the thyroid and parathyroid glands

Ya. V. Tielushko — 2024-04-22

The combination of thyroid and parathyroid gland pathology is a rather rare combination of diseases that occurs in 2.0–5.0 % of patients with thyroid pathology, and their combination in the population is less than 0.1 %.

The aim of the study. To improve the diagnosis and treatment of patients with combined pathology of the thyroid and parathyroid glands.

Materials and methods. The retrospective analysis covers the period from January 2013 to December 2023, during which 912 patients with thyroid pathology were examined and operated on. Examination of patients was carried out according to the method of diagnosis of combined surgical pathology developed by us (utility model patent No. 128139, Ukraine). The gender structure was dominated by female patients: 773 (84.8 %) and 139 (15.2 %). The average age of patients in the study group was 54.9 ± 11.7 years.

Results. After the examination, combined surgical pathology was found in 201 (22.1 %) patients. In 36 (17.9 %) of them, the pathology of the prostate gland was detected as a concomitant disease. In the structure of parathyroid pathology in 35 (97.2 %) patients, a benign lesion of the prostate gland was detected, in 1 (2.8 %) – cancer of the parathyroid gland. In the structure of the main thyroid pathology, 14 (38.9 %) patients were diagnosed with multinodular euthyroid goiter, 4 (11.1 %) with mononodous euthyroid goiter, 9 (25.0 %) with diffuse toxic goiter, 3 (8, 3 %) – mononodous toxic goiter, 6 (16.7 %) – papillary thyroid cancer. Clinical symptoms of hypoparathyroidism were observed in 21 (58.3 %) patients after surgery. In 3 (8.3 %) patients, seroma of the neck wound was detected in the postoperative period. There were no fatalities.

Conclusions. The use of the developed method of diagnosing combined surgical pathology makes it possible to detect concomitant surgical pathology in 22.1 % of patients with endocrine diseases, which requires simultaneous operative intervention. In the structure of combined surgical pathology, in 17.9 % of cases, a combination of diseases of the thyroid gland and parathyroid gland was observed. Simultaneous surgical intervention for combined thyroid pathology and diseases of the thyroid gland does not lead to an increase in perioperative complications and mortality.

Features of quality of life formation in children with visual impairments

L. I. Denysiuk — 2024-04-22

The relevance of the study is determined by the importance of complete healthy visual perception for quality of life and productivity in childhood. Prognostic calculations by international experts indicate increasing trends in the prevalence of ophthalmic pathology, with projections suggesting that by 2050, practically one-third of the world’s population will have visual impairments, the vast majority of which are diagnosed in childhood.

Aim. To study changes in the quality of life of children of different ages, its components, which continue to form during childhood under the influence of diagnosed ophthalmic pathology.

Materials and methods. We analyzed the results of a sociological study using adapted versions of the standardized Children’s Visual Function Questionnaire (CVFQ). Research methods included: medical-statistical, analytical-synthetic, sociological survey. The medical-statistical method involved calculating the standard deviation (σ – sigma) and standardized values of life quality assessment components (according to the CVFQ standardized questionnaire processing instructions).

Results. The sections of CVFQ cover six main categories of children’s quality of life: self-perception of general health status; self-assessment of vision; skills; personality status; support and family impact; treatment-related restrictions. In total, the adapted questionnaire version for children up to 3 years old contained 35 questions, and for children older than 3 years old, 40 questions. The main group included 788 individuals (of which 380 (48.2 %) had children under 3 years old and 408 (51.8 %) had children over 3 years old). The control group included 590 individuals (260 (44.1 %) had children under 3 years old and 330 (55.9 %) had children over 3 years old).

The research results prove the prospects of implementing medical-preventive strategies in providing primary and specialized ophthalmic medical care, considering the significant impact of ophthalmic pathology on the formation of quality of life components in children of different ages. It is proven that the prevalence of ophthalmic pathology increases with the age of children.

Conclusions. The significant medical and social importance of visual function disorders at different ages potentially threatens disability, socialization disorders, and productivity of ophthalmic patients. The growing medical and social significance of eye diseases nowadays imposes updated requirements for organizing the provision of ophthalmic care to various segments of the population.

Influence of zinc supply on the course of infectious diarrhea in children of early age

V. V. Pechuhina — 2024-04-22

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn).

Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient.

Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5^th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5^th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis.

Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.